Basic Information
| Provider Information | |||||||||
| NPI: | 1013152123 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NY MEDICAL HEALTHCARE P.C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1000 NORTHERN BLVD | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | GREAT NECK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 110215321 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5164820500 | ||||||||
| FaxNumber: | 5164665565 | ||||||||
| Practice Location | |||||||||
| Address1: | 1000 NORTHERN BLVD | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | GREAT NECK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 110215321 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5164820500 | ||||||||
| FaxNumber: | 5164665565 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/04/2008 | ||||||||
| LastUpdateDate: | 12/04/2008 | ||||||||
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| AuthorizedOfficialLastName: | GOLYAN | ||||||||
| AuthorizedOfficialFirstName: | BIJAN | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7187936300 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | D.O. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 01591780 | 05 | NY | MEDICAID |